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Lancet Commission on dementia prevention, intervention and care identifies 12 modifiable risk factors accounting for 40% of dementias

Thursday 30 July 2020

In the 2019 Alzheimer Europe Yearbook on the prevalence of dementia, we estimated that the number of people with dementia in Europe would double by 2050, to over 14 million in the European Union alone. Published on 30 July, the 2020 Lancet Commission on dementia prevention, intervention and care identifies twelve modifiable risk factors that may account for 40% of these cases. Theoretically, modification of these risk factors could prevent or delay the development of dementia, particularly in low- and middle-income countries where more dementias occur and where risk factor prevalence is higher.

The 2017 Lancet Commission on dementia prevention, intervention and care identified nine modifiable risk factors associated with increased dementia prevalence: less education, hypertension, hearing impairment, smoking, depression, obesity, diabetes, physical inactivity and low social contact.  In their 2020 update to the Commission report, Professor Gill Livingston and coauthors have added three more modifiable risk factors to this list: excessive alcohol consumption, traumatic brain injury and air pollution. 

Their wide-ranging report, which is based on a comprehensive analysis of hundreds of research studies and publications, identifies lifestyle factors in early life, midlife and later-life that could be targeted by individual-level and policy interventions.  Maintaining high levels of cognitive stimulation in early life (through schooling, for example) could reduce dementia risk by 7%. In midlife, hearing loss has the most substantial effect on dementia prevalence, accounting for 8% of cases, followed by traumatic brain injury (3%) and hypertension (2%).  Several modifiable risk factors are identified as having an impact in later life; in particular, smoking (5%), depression (5%) and social isolation (4%) contribute substantially to dementia.

The report also presents the latest evidence on interventions and care for dementia, including evidence for the utility of cholinesterase inhibitors, cognitive and physical training, and drugs to treat neuropsychiatric symptoms of dementia. Person-centred, evidence-based psychosocial interventions are shown to have some benefit in the treatment of the latter, while cognitive stimulation therapy is associated with small-to-moderate improvements in overall cognition.    

Importantly, the Commission authors identify several strategies for dementia risk reduction.  At an individual level, the Commission recommends actions to reduce hypertension, obesity and diabetes, suggests the use of hearing aids for hearing loss and discourages drinking more than 21 units of alcohol per week.  At a policy level, governments are urged to prioritise childhood education for all, and to develop policies that encourage social, cognitive and physical activities across the lifecourse. Ultimately, all actions should aim to support the wellbeing of people with dementia and their caregivers, via interventions that are individualised and consider the person as a whole.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30367-6/fulltext#seccestitle400

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